[Show abstract][Hide abstract] ABSTRACT: SUMMARY Objectives: Nonsteroidal antiinflammmatory drugs are recommended for the multimodal analgetic management of postoperative pain and may have significant opioid-sparing effect after major surgery. Preemptive analgesic efficacy of nonsteroidal antiinflammatory drug diclofenac have not been evaluated after major orthopedic surgery. This study was designed to determine whether the administration of a preemptive doses of diclofenac to patients who have undergone anterior cruciate ligament reconstruction would enhance analgesia, and/or decrease consumption of opioid analgetic fentanyl. Patients and methods: We evaluated 80 patients undergoing anterior cruciate ligament reconstruction. The patients were divided into two groups: ones preemptively, the night before and for 48 hr after operation, received oral diclofenac and others placebo. All patients postoperatively received combined intraarticular analgesia, continious 24-hr intravenous infusion of 200 mg tramadolum and 2,5 g metamisolum and intravenous fentanyl as needed. The outcome measures included visual-analog pain scores at rest and movements preoperatively and four times during 48 hours and the total dose of fentanyl during 24 horus. Results: The total dose of fentanyl were significantly less in the diclofenac group, and pain scores were significantly less in the diclofenac group at rest and movements than in the control group (p<0,001). Conclusion: Preemptive diclofenac demonstrated an improved analgesic effect during 48 hours postoperatively. Diclofenac can be reccommend as a preemptive component of multimodal pain management in patients undergoing anterior cruciate ligament reconstruction.
[Show abstract][Hide abstract] ABSTRACT: Aim To assess awareness and use of evidence-based medicine (EBM) databases and The Cochrane Library among physicians in Croatia. Methods A cross-sectional study with a telephone survey was performed among 573 physicians (88.6% response rate from 647 contacted physicians) from family practice and 4 major university hospital centers in Croatia. The main outcome measures were physicians’ awareness of The Cochrane Collaboration, awareness and use of The Cochrane Library, access to EBM databases, and access to internet at work. Results Overall, 54% of respondents said they had access to EBM databases, but when asked which databases they used, they named mostly non-EBM databases. The question on the highest level of evidence in EBM was correctly answered by 53% respondents, 30% heard of The Cochrane Collaboration, and 34% heard about The Cochrane Library. They obtained information about The Cochrane Library mostly from colleagues and research articles, whereas the information about EBM was gained mainly during continuous medical education. There were more respondents who thought The Cochrane Library could help them in practice (58%) than those who heard about The Cochrane Library (30%). Only 20% of the respondents heard about the initiative for the establishment of the Croatian branch of The Cochrane Collaboration. Family physicians had significantly lower level of awareness, knowledge, and use of EBM and The Cochrane Library than physicians from university hospitals. Conclusion There is low awareness about EBM and The Cochrane Library among physicians in Croatia, which creates a need for educational interventions about EBM for the benefit of health care in Croatia.
[Show abstract][Hide abstract] ABSTRACT: Background and Purpose: Regional anesthesia is the choice for patients undergoing preventive open carotid surgery. Recently intermediate cervical plexus block has been described as a reliable and safe anesthesia technique in comparison with superficial and deep cervical plexus block. The aim of our study was to assess the complications of intermediate cervical plexus block in high risk patients. Materials and Method: The study was performed in 29 ASA III and ASA IV patients with the intermediate cervical plexus block for carotid endarterectomy from January 2006 till November 2008 in the University Hospital Zagreb. The following data were collected: age, sex, ASA status and preoperative disease. Furthermore, intraoperative and postoperative complications associated with intermediate cervical plexus block and carotid endarterectomy were recorded. Results: Median age was 69 years (range, 46 – 82 years). One patient developed Horner’s syndrome, three patients developed transitory ischemic attack, one developed stroke intraoperatively and died, seven patients developed transitory hemodynamic instability, one was hypotensive in the postoperative period and required vasoactive support. Conclusion: Intermediate cervical plexus block is safe and effective for carotid endarterectomy in high risk patients.